Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists. A place to talk; no one has to listen.
All patient vignettes are confabulated; the psychiatrists, however, are mostly real.
--Topics include psychotherapy, humor, depression, bipolar, anxiety, schizophrenia, medications, ethics, psychopharmacology, forensic and correctional psychiatry, psychology, mental health, chocolate, and emotional support ducks. Don't ask. (It's not Shrink Wrap.)

Wednesday, September 23, 2009

This is a post for ClinkShrink, but she's so busy lately that I thought I'd stick it up.

So in Maryland, to the best of my knowledge (and I could be wrong) we have this idea that if someone is criminally insane and needs hospitalization, they should probably stay in the hospital. I'm not aware that forensic facilities take people on field trips. Like I said, I could be wrong, I don't treat inpatients and I don't work with designated forensic patients. The piece below caught my attention, it's from The Seattle Times:

On Thursday, Phillip Arnold Paul, who had been committed after being found not guilty by reason of insanity in the slaying of an elderly woman, disappeared during a field trip to the Spokane County Interstate Fair with 30 other Eastern State Hospital patients and 11 staff members. The escape prompted an extensive manhunt that ended Sunday when Paul, 47, surrendered to authorities near Goldendale, Klickitat County, about 180 miles from the fair.

It was the second time that Paul had escaped from state custody.

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The photo, by the way, is of a cow at the Maryland State Fair, and has nothing to do with the story of the escapee from the state hospital in Spokane. I just like cows.

If he was really insane when he did the killing, shouldn't he just be treated like any other patient? On the other hand, if we want to punish him it makes sense to keep him in jail. It's a dilemma. I think few people believe insanity acquittees are truly not guilty.

As the mom of a 20 year old son with schizophrenia I wonder could he of been insane at the time of the crime and yet sane enough, months later, with treatment, been well enough to go to on the trip?Maybe there should be a punishment/penalty if/when the person becomes sane again.

Perhaps it's telling that he "escaped." I don't believe that's the usual for patients on a trip. And he escaped twice? Usually patients who are dangerous/ potentially dangerous are kept on locked units if they are elopement risks.

Community outings in general are a big no-no at the mental hospital where I work. Sex offenders are kept in a separate building and to my knowledge they're only allowed to go outside for a supervised walk. In a different building is one patient who was found not guilty by reason of insanity, and he is allowed to earn certain privileges but he is not allowed to attend a community outing, nor is any patient.